Army updates suicide-prevention guidance
December 4, 2009
FORT SAM HOUSTON, Texas (Army News Service, Dec. 4, 2009 -- The Army Suicide Prevention Task Force and the Army's vice chief of staff are trying to get out the word about what Soldiers and leaders can do to improve behavioral health and prevent the loss of life through suicide.
One way this message is getting out is through updated and improved regulations, including the Army Health Promotion regulation (AR 600-63), Army Suicide Prevention pamphlet (PAM 600-24) and FM 6-22.5, Combat and Operational Stress Control Manual for Leaders and Soldiers.
"FM 6-22.5 outlines leader responsibilities pertaining to Soldiers and behavioral health," said Vice Chief of Staff of the Army Gen. Peter Chiarelli in an All Army Activities or ALARAC message. "It provides detailed guidance on supporting Soldiers and families through all phases of the ARFORGEN cycle; to include command directed evaluations, facilitating leader led after action debriefs and updated sleep guidance as an operational planning factor."
Some of the messages are:
Aca,!Ac Combat and operational stress affects everyone. No Soldier who experienced combat or Family member will remain unchanged.
Aca,!Ac Most Soldiers adapt, but some may struggle with combat and operational stress reactions.
Aca,!Ac Shell shock, battle fatigue, battle exhaustion were names formally used to describe COSR.
Aca,!Ac It is leaders who have the greatest impact implementing successful combat and operational stress control programs. They must set conditions to allow Soldiers to talk about and share their combat experiences.
Aca,!Ac To help build resiliency in Soldiers and in their units, leaders should integrate COSC teams, behavioral health and medical personnel into their training and pre-deployment exercises.
AR 600-63 tells commanders they are responsible to ensure that Soldiers identified for suicide risk or related behaviors are managed in a consistent manner. It also promotes the battle buddy system, improves unit watch suicide intervention procedures and requires commanders establish a policy that prevents Soldiers from being belittled for seeking or receiving behavioral health assistance.
PAM 600-24 promotes community health promotion councils and suicide prevention task forces. It provides standard membership and responsibilitiesfor these programs throughout the Army.
Bruce Shahbaz, a medical analyst for the initiatives group of the Suicide Prevention Task Force, said changes are being made to reduce barriers that may make it difficult for Soldiers to receive behavioral-health care.
"Barriers to care include a behavioral-health appointment backlog, when the demand for care exceeds the Army's ability to provide treatment. The Army is increasing the number of psychiatrists, psychologists, social workers, and psychiatric nurse practitioners to help decrease this 'backlog,'" Shahbaz said.
"Another barrier to care is the fact that Soldiers don't want to miss unit training events (rifle ranges, etc.), so MEDCOM is expanding the duty hours for behavioral-health services in some locations to make evening and weekend appointments available for Soldiers and their Families. The goal is make it easier for Soldiers to get the medical treatment they need to return to full duty capability," he added.
Another recent message from Chiarelli highlighted issues that may be of particular concern in the six to 12 months following return from deployment.
The message emphasized suicide, behavioral-health issues, alcohol/substance abuse, domestic violence, barriers to wellness, risk-taking behavior and non-visible injuries (hearing, traumatic brain injury, and post-traumatic stress disorder).
"Several key recommendations for Army leaders during post-deployment reintegration are suggested. They include: develop a strong mentoring system within each unit; visit Soldiers in their barracks between 60-120 days of redeployment to better understand their environment; schedule unit yellow-ribbon events and attend the events to better understand your Soldiers and their family members, the message states.
It goes on to encourage self care and battle buddy support; use of behavioral-health providers to conduct a unit needs assessment and arrange for assistance based on the results; discusses barriers to care for psychological health with Soldiers; reinforces in- and out-processing procedures for Soldiers as they PCS; encourages healthy lifestyles and emphasizes comprehensive fitness; and reinforces the importance that all Soldiers are valuable assets to their units and the Army.
Another concern has been maintaining Soldiers' privacy and ensuring Protected Health Information is not disclosed inappropriately. PHI is protected by law.
"Army Medical Command has recently updated its policy on Protected Health Information to help clear up the confusion surrounding behavioral-health care. Seeking behavioral-health treatment does NOT trigger 'command notification,'" Shahbaz said.
Privacy rules recognize that the military mission may require PHI to be disclosed to commanders without the Soldier's authorization in certain circumstances. Those circumstances might include necessity to determine the Soldier's fitness for duty, or preventing suicide or acts of violence. Unit commanders must limit further release or disclosure of Soldiers' PHI to only those who need to know.
Leaders acknowledge that unintended release of information increases stigma and barriers to care.
Chiarelli addressed post-traumatic stress disorder and traumatic brain injuries resulting from combat during the recent annual meeting of the Association of the United States Army.
"I want to change the stigma linked to these wounds," Chiarelli said. "They are in fact real. These are not phantom issues made up by weak Soldiers. They are as real as if you fell and broke your leg or lost an arm."
The Defense Center of Excellence for Psychological Health and Traumatic Brain Injury sponsors the 'Real Warriors Campaign', a multimedia public education effort designed to reduce the stigma associated with seeking care or treatment with psychological health.
"Stigma is a very difficult issue for the Army to address," said Shahbaz. "Every Soldier comes into the Army with preconceived notions of behavioral health treatment - many of those notions are not positive. Americans, in general, have many negative preconceived notions about behavioral health treatment. The Army is working hard to encourage Soldiers to seek help to return them to full duty status."
"The Army has strongly supported the Military Family Life Consultants and the Military One Source program. Both offer confidential and convenient counseling to help Soldiers and Family Members," Shahbaz said.
Military One Source may be reached at 1-800-342-9647 or online at www.militaryonesource.com
"The Army also is telling Soldiers that seeking behavioral-health treatment related to deployment stress will NOT affect their security clearance," Shahbaz said. "Soldiers actively seeking assistance to resolve behavioral health issues actually reduce their vulnerability so seeking counseling can be a positive factor in obtaining and sustaining a security clearance."